Home Practice Management The New Associate: A Guide To Professional and Financial Success

The New Associate: A Guide To Professional and Financial Success

by Dr. Timothy Kosinski

Mentorship is a rejuvenated trend in our dental profession. Sharing our knowledge and experience to the next generation of dentists is both professionally and financially rewarding.

As the current Associate Editor of the Academy of General Dentistry journals, I recently wrote an editorial that dealt with current trends in the dental education landscape. In this discussion I presented my opinions on the importance of mentorship. I had practiced alone since my previous associate left the practice several years ago. I have not considered bringing another person into the practice since I thought that another associate may be disruptive.

Last Spring, a longtime dental implant associate reached out to me telling me that her daughter was graduating from my dental school and she asked if I knew anyone in the area who was considering hiring an associate. Initially, I could not think of anyone, but I told her to have her daughter stop by to see if I could help. I had no intention of hiring anyone at that time, but I wanted to direct her in a positive direction.

Joslynn K. Bauer had just graduated from dental school when she presented to my office. We had some cursory conversations on how she should proceed in the interview process with dentists who may be seeking an associate dentist. My comments to her included: “Dentistry is a wonderful profession but a challenging job.” I told her something my father always told me, that is, “you really need to love what you do to be successful.” “Financial rewards come with hard work, compassion and empathy.”

I suggested that as she interviewed she refrain from making financial demands on her potential employer. Several of my colleagues relayed to me how recent graduates would have specifics stipulations on accepting positions. This made the potential employer feel uncomfortable with the financial responsibilities of a guaranteed salary employment agreement.

Joslynn impressed me as she engaged my words. She was spirited and she comprehended her current limits, but wanted to develop professionally. I saw something in her that reminded me of me when I was just starting out. This recent graduate from my dental school wanted to magnify her knowledge. In that instant, I decided to bring her onto our dental team.

Many dental school graduates sign contacts with a corporation or dental group. An independent contractor agreement is often presented and accepted by the recent doctor who is referred to as the “contractor.” The contractor thus agrees to render dental services to present and future patients of the dentist owner. There are usually terms to the agreement following an effective date and is subject to provisions for termination. The parties involved can extend the agreement per mutual consent, however, the agreement is automatically renewed for one year periods unless either party notifies the other of the intention to terminate at least 30 days prior to the end of the current term. This protects both the owner/dentist and the contractor. The contractor receives a fee for services calculated, for example, thirty (30) percent of collections resulting from dental services provided by the contractor. Laboratory bills are often split between the contractor and owner dentist. The contractor’s fee is paid monthly, on the first business day of the month for the preceding month, and will include payment on all such collections received prior in the prior month for which the fee has not yet been paid. However, as a recent graduate, generating significant dentistry may be challenging. Therefore, there is often a guaranteed minimal average annual compensation made to the contractor, to help him/or her become financially stable. For example, this amount may be $125,000 per year, as long as the contractor provides services under the agreement for a full two -year initial term. The owner dentist agrees that the minimal compensation, limited to the initial term. However, discretionary periodic adjustments to the payments made to the contractor will be made from time to time, so that the 30% payment on collections will balance out over time. The owner dentist thus assumes some initial outlay until the contractor is able to produce enough dentistry to cover the guaranteed salary. This often takes a full two years before the practice is indeed profitable by having the associate in place.

With this guarantee of a salary comes the requirement to produce a volume of dentistry and collections. The first year of the contract is usually financially rewarding for the recent graduate, and allows them to pay down a bit of their school debt, but also start a personal life with maybe a house or a nicer car. Sometimes it is a challenge to meet the production goals to match the salary provided. There is often a carry over to the next year which must be met. For example, if a guaranteed salary of $125,000 is provided to the contractor, the recent graduate would need to produce approximately $417,000 per year. If unable to reach this production goal, there would be a carry over to year two. The dentist owner normally takes responsibility for the salary initially, but near the end of this agreement, there may be a significant loss of salary to the associate as guaranteed salary is balanced with compensation at the agreed upon percentage of revenue collected.

Normally the contractor is responsible for all expenses which are not specifically provided by the owner dentist, including professional license fees, professional dues, subscription expenses professional meeting and education expenses, automobile, cellular phone, fringe benefits, worker’s compensation and professional liability insurance. Vacation time is allowed but not compensated for. If employment does not work out there is a termination clause which allows either party to terminate it, without cause, for any reason, upon 120 day written notice. However, the contractor can be terminated immediately for cause, which may include suspension, revocation, cancellation, restriction or limitation of the contractor’s license, criminal conviction, unprofessional or unethical conduct, or mistreatment of patients.

As Dr. Bauer became a part of my professional team, I made it a point to introduce her to each of our patients, and she was well received and accepted by all. Within three weeks, she was an integral part of the team, taking some of the load off me and developing a professional rapport with staff and patients. Her clinical skills were already exceptional, yet she wanted to keep learning. What an opportunity. I am reminded that we all start somewhere, and — with the proper mentorship and clinical experience — we achieve professional excellence.

Mentoring is a critical part of dentistry, and being able to share our knowledge with the next generation is so rewarding.

What can these young graduates realistically expect to produce and collect in practice? There may be severe financial pressure to produce in order to pay off educational debt. Specifically, I would like to share some of her dental school debt numbers that Dr. Bauer provided me. The University of Detroit Mercy School of Dentistry is a private school, and she relayed that her student loan debt is currently at $450,000. This is an incredible sum. Interest rates for her loans range from 5.31% to 7.60%.

Dental education is a huge investment for these young people. Due to their debt level, they must create an income to survive. Additionally, recent graduates should be motivated to learn, excel, continue their educations and provide a service to the public in an ethical and empathetic manner. This is a lot to ask.

I thought about how this new clinician came to me for guidance. Once accepted into my practice, I challenged myself to set her up for professional and financial success. Mentorship is important to me, as I had been blessed with tremendous mentors throughout my career. Through this mentorship from one generation to the next our profession is elevated. I know this relationship will be rewarding to me financially. Passing my knowledge and experience to the next generation is certainly gratifying

So I asked Dr. Bauer to relay her side of this new experience and how our relationship compares to many of other recent graduates. Here is her story:

“What do you want to be when you grow up?” a constant question I was asked when I was young. Most kids my age had no idea what they wanted to be; my response however was consistently “a doctor”. Flash back to my 5th birthday party when I opened one of my presents which happened to be the new Barbie dentist! This would become my favorite toy to play with, and little did I know, it would spark my interest in one day becoming a dentist.

Graduations came and went, first high school, then college, and finally dental school. My 5 year old self would be so proud to know that with hard work and determination her dream came true. Towards the end of dental school, as graduation crept up, everyone’s new question was “where do we go from here?” This was something I didn’t have the answer to yet, I did know however that I wanted a great mentor. Mentorship has and will always be a big part of my career, and due to mentorship when I was younger, it got me to where I wanted to be. To anyone wondering how to find the job that suits you best, my recommendation is to be patient, interview all over, and don’t accept an offer until it feels right to you.

My job search ended when my mom decided to make a call to a dear friend of hers, Dr. Timothy Kosinski. She asked him if he knew of anyone who was hiring, as her youngest daughter was a soon to be a dentist in need of a job. Being an amazing mentor to so many, Dr. Kosinski asked me to come in and meet him so that he could help. Although he himself was not planning on hiring anyone, he decided he could help a fellow alumnus from University of Detroit Mercy Dental School find a job that suited me best. One of the first things that he said to me was “ Dentistry is a great profession, but a very hard job, you really need to love what you do, and as long as you do a good job at a fair price, you will always be busy and the financial rewards will come with time.” I loved what he said and knew that he truly wanted to help his community. He asked about my experience in searching for the right job and I told him that I wanted to find a job that gave me the opportunity to ease into a practice, as I knew what I was capable of, but also knew that I still had a lot to learn. He respected those words and saw my enthusiasm for the profession but knew that I was wanting and willing to learn more. In that moment he decided to give me a chance and told me to come back Monday morning to start what we called a “trial run” at the office. As weeks went by, our trial run ran out and we realized that we worked really well together, my name was even put on the door after about a month. I had found my perfect job.

Dr. Kosinski mentors me on a daily basis and allows me to grow at my own pace. Unlike corporate dentistry, we have no contract, no daily requirements and no pressure. I told him the procedures that I did and did not feel comfortable doing yet, and he respected that. I am able to watch procedures that he does and learn from those experiences, which help in my day to day practices and capabilities. He gave me confidence. I feel comfortable asking for help when I need it and know that he will always be there to lean on.

We decided that a formal independent contractor’s agreement was not desired by either of us. What contracts have that we don’t is a binding agreement for a several year period, a guaranteed annual compensation paid based on years worked and a non-compete clause. Since the holiday week end was coming up, Dr. Kosinski opened his office for me to observe and evaluate to see if we were indeed compatible. Once we decided that we had a good fit, I started providing dental treatment to patients within the practice. I believe in working hard and that with this hard work will come great rewards. Therefore, I have no bonuses or anything like that, I treat patients, within my training and abilities, and get paid accordingly, it’s as simple as that.

Our practice however is a bit different than most. We do not accept insurance as payment and therefore do not have to wait on claims or payments. Most contracts allow for the dentist to receive 30% of collections, but when collections take weeks to months to process due to insurance companies, the dentist may feel as though they are not getting paid enough. This can sometimes be rectified by advancements in payments by their employers, but with this comes the constant thought of owing someone. In our practice, I am paid by 30% of collections based on production minus onehalf my dental laboratory bills. This means that the moment the patient pays for their treatment I am paid, no waiting on insurance claims.

Our practice also believes very strongly in continuing education. I knew that whatever job I chose would need to be on board with continuing education courses, which can sometimes mean days off of work. Dr. Kosinski is basically the king of CE, proving once again that I found my dream job. He travels 42 weekends a year, yes you heard that right, presenting lectures on various dental procedures, his specialty being implants. With his guidance and financial help, I will have approximately 130 CE hours by the end of December, which is a lot of course hours since graduating earlier this year in May. When the requirement for our dental licensing is only 60 CE every 3 years, I’d say I’m well on my way. He has also guided me in the surgical placement of 3 implants! This is something that was beyond my wildest dreams and couldn’t have been made possible without Dr. Kosinski.

One of the biggest helps that I have had thus far within our office is having Dr. Kosinski’s number one assistant, Cheri, to myself. He thought that with me being a new dentist in a new office, this was the right choice, and he couldn’t have been more correct. Cheri has been with Dr. Kosinski for over 28 years and knows the ins and outs of everything in the practice. Some of the patients have been coming to the practice for over 30 years, and Cheri knows them all. Dentistry is not just about the procedures we do, but also about getting to know our patients and building relationships with them. But when it comes to procedures, it helps having someone who knows what instrument to hand you before you even have to ask.

All in all, Dr. Kosinski has taught me and many others the importance of mentorship, trusting in yourself and knowing that you are capable of great things if you put in the work. From running his own unique practice, to lecturing around the country, to placing thousands of implants a year, he is the best in the business. He has been such a blessing to myself and my career and I am very thankful to be working alongside of him every day and learning from him.

The mentor/recent dentist relationship can be both professionally and financially rewarding for both parties involved. The more education my associate takes and an increase in procedures provided will take stress of running the practice away from me. Our patients appreciate quicker appointment scheduling. I am complimented and proud of Dr. Bauer and her professionalism. Our patients accepted her well and a comment often heard is, “you waited a long time to bring someone into the practice, and if you chose her, she must be really good.” I smile and agree with the evaluation. The transition from a solo practitioner to having a recent associate has been seamless to say the least. I am appreciative of Josylnn’s enthusiasm. Giving back to the profession is what it is all about. But I too am getting a lot back from our relationship.

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Dr. Timothy Kosinski

Dr. Timothy Kosinski is an Affiliated Adjunct Clinical Professor at the University of Detroit Mercy School of Dentistry, serves as the Associate Editor of the national AGD journals and was recently named Editor of Dentistry Today Implants.  He is a past president and editor of the Michigan AGD. Dr. Kosinski has placed over 14,000 dental implants and published over 200 articles on the clinical and prosthetic phases of implant dentistry. He received the Academy of Dentistry International’s Humanitarian Award “in recognition of significant contributions to the enhancement of the quality of life and the human condition.”  Dr. Kosinski can be reached at 248-646-8651, drkosin@aol.com or www.smilecreator.net.

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